title: The relationship between body mass index and mental health among Iraq and Afghanistan veterans.
abstract: BACKGROUND
  Obesity is a growing public health concern and is becoming an epidemic among veterans in the post-deployment period.
  
  
  OBJECTIVE
  To explore the relationship between body mass index (BMI) and posttraumatic stress disorder (PTSD) in a large cohort of Iraq and Afghanistan veterans, and to evaluate trajectories of change in BMI over 3 years.
  
  
  METHODS
  Retrospective, longitudinal cohort analysis of veterans' health records
  
  
  METHODS
  A total of 496,722 veterans (59,790 female and 436,932 male veterans) whose height and weight were recorded at the Department of Veterans Affairs (VA) healthcare system at least once after the end of their last deployment and whose first post-deployment outpatient encounter at the VA was at least 1 year prior to the end of the study period (December 31, 2011).
  
  
  METHODS
  BMI, mental health diagnoses.
  
  
  RESULTS
  Seventy-five percent of Iraq and Afghanistan veterans were either overweight or obese at baseline. Four trajectories were observed: "stable overweight" represented the largest class; followed by "stable obese;" "overweight/obese gaining;" and "obese losing." During the 3-year ascertainment period, those with PTSD and depression in particular were at the greatest risk of being either obese without weight loss or overweight or obese and continuing to gain weight. Adjustment for demographics and antipsychotic medication attenuated the relationship between BMI and certain mental health diagnoses. Although BMI trajectories were similar in men and women, some gender differences were observed. For example, the risk of being in the persistently obese class in men was highest for those with PTSD, whereas for women, the risk was highest among those with depression.
  
  
  CONCLUSIONS
  The growing number of overweight or obese returning veterans is a concerning problem for clinicians who work with these patients. Successful intervention to reduce the prevalence of obesity will require integrated efforts from primary care and mental health to treat underlying mental health causes and assist with engagement in weight loss programs.
authors.affiliation: San Francisco VA Medical Center, 4150 Clement Street (116-P), San Francisco, CA 94121, USA. Shira.Maguen@va.gov
authors.forename: Shira
authors.initials: S
authors.lastname: Maguen
authors.forename: Erin
authors.initials: E
authors.lastname: Madden
authors.forename: Beth
authors.initials: B
authors.lastname: Cohen
authors.forename: Daniel
authors.initials: D
authors.lastname: Bertenthal
authors.forename: Thomas
authors.initials: T
authors.lastname: Neylan
authors.forename: Lisa
authors.initials: L
authors.lastname: Talbot
authors.forename: Carl
authors.initials: C
authors.lastname: Grunfeld
authors.forename: Karen
authors.initials: K
authors.lastname: Seal
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008137:Longitudinal Studies; D008297:Male; D008603:Mental Health / Q000639:trends*; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000523:psychology*; D058014:Veterans Health / Q000639:trends; D055815:Young Adult